RESUMO
OBJECTIVE: To develop the principles for the treatment of traumatic intracranial aneurysms after combat damage to skull and brain. MATERIAL AND METHODS: There were 18 patients with traumatic intracranial aneurysms from February 2022 to the present. Of these, 15 ones had gunshot penetrating wounds of the skull and brain. In 3 cases, aneurysms developed after explosive injury. All patients underwent computed tomography (CT) of the brain, CT angiography of brain vessels and selective cerebral angiography. We analyzed nature of brain damage, trajectory of the wounding projectile and aneurysm location to determine predictors of traumatic intracranial aneurysms. Surgical treatment was performed in all cases. RESULTS: Hemorrhagic manifestations were observed in 11 patients. In 4 cases, traumatic intracranial aneurysms were diagnosed before rupture. Blunt head injury was followed by subarachnoid hemorrhage in 2 cases and ischemic stroke in 1 case. Endovascular or microsurgical intervention was performed depending on location of aneurysm, clinical manifestations and severity of brain damage. In case of distal aneurysms, endovascular and microsurgical destructive interventions prevailed. At the same time, proximal aneurysms (within or below the circle of Willis) required reconstructive endovascular treatment. CONCLUSION: Traumatic aneurysms should be suspected in all patients with penetrating craniocerebral injuries. Follow-up is contraindicated for traumatic intracranial aneurysms due to high risk of hemorrhage.
Assuntos
Lesões Encefálicas , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Angiografia Cerebral/métodos , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: To evaluate safety and feasibility of transradial approach for neuroendovascular procedures and to familiarize neurosurgeons and neuroradiologists with the capabilities and limitations of this approach, as well as technical features influencing its effectiveness. MATERIAL AND METHODS: A retrospective analysis was performed in 270 patients who underwent transradial neuroendovascular procedures between January 2015 and December 2019. Diagnostic and surgical interventions were performed in 203 (75.2%) and 67 (24.8%) patients, respectively. The authors comprehensively describe catheterization technique and choosing the instrument for effective and safe transradial access. RESULTS: The right vertebral and both common carotid arteries were the most accessible for selective catheterization (100% of cases). The left common carotid artery was catheterized in all cases, the left internal carotid artery - only in 92% of cases. If catheterization of the left vertebral artery was necessary, we used the left-sided radial approach. Conversion to femoral approach was required in 2.6% of cases for the left internal carotid artery disease (n=7). Radial artery occlusion occurred in 3.7% of cases (n=10) and was asymptomatic in all cases. We present a video clip (https://youtu.be/3wZ6O8u-lpk) devoted to various surgical interventions through radial approach. CONCLUSION: Radial approach is safe and feasible and may be used for neuroendovascular procedures.
Assuntos
Procedimentos Endovasculares , Artéria Radial , Artéria Carótida Interna , Cateterismo , Humanos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Estudos Retrospectivos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgiaRESUMO
Middle meningeal artery embolization as primary method for treatment of chronic subdural hematomas became more popular in past decade. There are few large case series (>150 patients) and literature reviews characterizing advantages and drawbacks of endovascular treatment and technical features of surgeries. In this manuscript, the authors report 11 patients with chronic subdural hematoma scheduled for middle meningeal artery embolization and review the literature data on this issue.
Assuntos
Embolização Terapêutica , Hematoma Subdural Crônico , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Artérias Meníngeas/diagnóstico por imagemRESUMO
OBJECTIVE: To develop a method for early (24 hrs after intervention) prognosis of functional outcome at discharge in patients after endovascular thrombectomy (EVT) in anterior cerebral circulation based on NIHSS. MATERIAL AND METHODS: A retrospective analysis of endovascular treatment in 362 acute stroke patients (189 men, 173 women, median age 69 years) with anterior circulation large vessel occlusion was performed in the regional vascular centers of St. Petersburg. RESULTS: The original scale (S10-10) developed for prognosis of functional outcome at discharge is based on total scores on 3 patterns: NIHSS 24 hrs after EVT (10 and less - 1, greater than 10 - 2), NIHSS improvement 24 hrs (greater than 10 - 0, 1-10 - 1, 0 and less - 2), older than 78 yr - 1. According to the total score, 5 grades are determined: 1 (good, mRs 0-2 75%, mRs 3-5 25%, mRs 6 0%), 2 (favorable, mRs 0-2 66%, mRs 3-5 26%, mRs 6 8%), 3 (unfavorable, mRs 0-2 14%, mRs 3-5 68%, mRs 6 18%), 4 (unfavorable with high mortality, mRs 0-2 1%, mRs 3-5 52%, mRs 6 47%), 5 (highly negative, mRs 0-2 0%, mRs 3-5 16%, mRs 6 84%). S10-10 greater than 2 indicates unfavorable prognosis. The scale allows accurate prognosis of functional outcome at discharge (AUC 0.89; AUC 0.84 in a validation cohort) and length of in-patient staying and time to death for S10-10 greater than 2. CONCLUSION: Accurate prognosis of functional outcome at discharge can be done 24 hrs after EVT in anterior cerebral circulation based on the widely used neurological scale (NIHSS) taking into account patient age.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Artéria Carótida Primitiva , Feminino , Humanos , Masculino , Alta do Paciente , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do TratamentoRESUMO
OBJECTIVE: Based on a retrospective analysis, to evaluate technical results and functional outcomes at discharge after endovascular thrombectomy (EVT) in anterior circulation out of 6-hours «therapeutic window¼ in patients with stroke. MATERIAL AND METHODS: The retrospective analysis of EVT in 594 acute stroke patients (303 male, 291 female, median age 69 years) with the anterior circulation large vessel occlusion was performed. EVT was carried out before 6 hrs in 550, later in 44 patients. Time to artery puncture was defined as a cut point. Patients were included in the study if they met the criterion for 0-6 hours «therapeutic window¼. RESULTS: No significant differences in functional outcomes at discharge assessed with the Rankin scale (mRs 0-2 29.8% and 20.5% p<0.19; mRs 3-5 38.7% and 38.6% p<0.99; mRs 6 31.5% and 40.9% p<0.2) and the rates of intracranial haemorrhage, haemorrhagic transformation and symptomatic haemorrhagic transformation (4% and 0% p<0.17; 20.9% and 29.5% p<0.49; 10.1% and 11.4% p<0.78) were observed in patients exposed to EVT before 6 hrs and later. CONCLUSION: EVT in anterior circulation stroke over 6 hrs «therapeutic window¼ based on the criterion for 0-6 hrs provides comparable functional outcomes at discharge without the increase in the frequency of intracranial haemorrhages, haemorrhagic and symptomatic haemorrhagic transformations.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Circulação Cerebrovascular , Feminino , Humanos , Masculino , Estudos Retrospectivos , Federação Russa , Trombectomia , Resultado do TratamentoRESUMO
The article presents a clinical case of segmental agenesis of the cervical ICA with collateral blood supply to the ICA territory through the intercavernous anastomosis and ascending pharyngeal artery with the branching primitive stapedial artery - the aberrant ICA variant. A feature of the case is a unique combination of the intercavernous anastomosis and the aberrant ICA, which provide collateral blood flow in cervical ICA agenesis. In the world literature, there are no reports of similar combinations. The discussion provides information on the stages of circle of Willis formation and presents a literature review of cases of intercavernous anastomoses associated with ICA agenesis.
Assuntos
Artéria Carótida Interna , Circulação Colateral , Anastomose Cirúrgica , PescoçoRESUMO
AIM: To assess technical results and close functional outcomes of acute ischemic stroke (AIS) in patients treated with endovascular thrombecomy (ET) in regional vascular centers (RVC) of St-Petersburg. MATERIAL AND METHODS: Retrospective analysis of 183 patients with AIS, including 143 patients with AIS due to a large intracranial vessel occlusion in anterior (AC) and 25 patients in posterior cerebral (PC) circulation, 15 with isolated extracranial carotid occlusion treated in 6 RVC in 2017 was performed. All patients underwent ET. RESULTS AND CONCLUSION: Effective reperfusion (mTICI 2b-3) was achieved in 71.5% (71.3% AC, 72% PC). On discharge, 35,7% patients had good (mRs 0-2) functional outcome (37.1% AC, 28% PC). The incidence of symptomatic intracranial hemorrhage (according to ECASS II criteria) was 10.7% (9.1% AC, 20% PC), the mortality was 29.2% (22.4% AC, 68% PC).). The results of our study show the possibility of effective and safe application of ET in patients with AIS in the anterior and posterior cerebral circulation in regional vascular centers of St.-Petersburg.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Trombectomia , Isquemia Encefálica/terapia , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Resultado do TratamentoRESUMO
AIM: To study cerebral autoregulation (CA) in region of the stenotic carotid artery. MATERIAL AND METHODS: The study involved 35 patients with critical stenosis of the carotid arteries, including 24 patients were asymptomatic and 11 patients with symptomatic course. Blood flow velocity in middle cerebral arteries was monitored using Multi Dop X (DWL, Germany) with simultaneous noninvasive systemic blood pressure registration (CNAP, Austria). CA was assessed by calculating the phase shift (PS) between spontaneous oscillations of blood flow velocity and blood pressure within the range of systemic Mayer waves (80-120 mHz). RESULTS: In 18 patients, the CA indicators were in the normal range (PS 1.2±0.3 rad). Seventeen patients, including asymptomatic as well as symptomatic types, had impaired CA (PS 0.2±0.2 rad and 0.3±0.2 rad, respectively). Reconstructive surgery, irrespective of clinical manifestations, led to the significant increase in PS (p<0.001) in the early postoperative period (0.9±0.5 and 0.9±0.3 rad, respectively). CONCLUSION: A significant variability in the cerebrovascular reserve capacity in symptomatic and asymptomatic types of carotid artery stenosis was found. CA can be used in determining the indications for surgical treatment and evaluation of its effectiveness in patients with stenosis of carotid arteries.
Assuntos
Encéfalo/irrigação sanguínea , Estenose das Carótidas/fisiopatologia , Circulação Cerebrovascular , Idoso , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Feminino , Homeostase , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Ultrassonografia Doppler TranscranianaRESUMO
Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spinal cord, causing segmental lesions of the spinal cord due to venous ischemia. Functional outcomes of treatment in SDAVF patients are favorable, but the rate of improvement varies from 25 to 100%, which complicates prediction of the treatment outcome. AIM: the study aim was to identify a relationship between fistula localization and clinical manifestations and evaluate the effect of disease duration and severity of neurological impairments on immediate and long-term treatment outcomes, based on analysis of the literature and own data. MATERIAL AND METHODS: In September 2016, we performed a PubMed search for publications using keywords 'spinal arteriovenous fistula', 'treatment', and 'outcome'. We selected publications containing information on the patient's age, fistula location, disease duration, and evaluation of symptom severity (Aminoff-Logue scale) preoperatively, postoperatively, and at least 3 months after surgery. The analysis also included data on patients operated on at the clinic. A total of 187 patients were included in the analysis. RESULTS: The fistula was most often located at the T6, T7, and T9 level, with motor disorders being more severe for fistulas located at or below the T9 vertebra. Surgical isolation of the fistula improved the functional state of patients, with patients under the age of 60 years having a better prognosis for recovery of impaired functions. Motor disorders significantly regressed in the early postoperative period in all patients, but in the long-term period, there was worsening of motor disorders in patients with a better baseline functional state.
Assuntos
Malformações Vasculares do Sistema Nervoso Central , Isquemia , Transtornos Motores , Doenças da Medula Espinal , Fatores Etários , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Isquemia/cirurgia , Masculino , Transtornos Motores/diagnóstico por imagem , Transtornos Motores/fisiopatologia , Transtornos Motores/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgiaRESUMO
The authors present dopplerographic predictors of cognitive status dynamics of patients undergoing carotid angioplasty with stenting. It was stated that the cognitive status dynamics depended on the initial condition of patients and reactivity coefficient on hypercapnia in target vascular pool.
Assuntos
Artérias Carótidas/cirurgia , Estenose das Carótidas , Circulação Cerebrovascular/fisiologia , Transtornos Cognitivos/diagnóstico , Cognição/fisiologia , Complicações Pós-Operatórias/diagnóstico , Idoso , Angioplastia/efeitos adversos , Angioplastia/métodos , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Stents , Ultrassonografia Doppler Dupla/métodosRESUMO
Today vertebral hemangioma is not completely understood entity, neither its pathogenesis nor optimal treatment is determined. Nowadays in majority of clinics in this country ineffective radiotherapy remains the first-line treatment. We analyzed results of treatment of 205 patients (286 lesions) with aggressive hemangiomas operated in Department of Neurosurgery of Military Medical Academy and Department of Nuclear Medicine of of Russian Scientific Center of Radiological and Surgical Technologies (Saint-Petersburg, Russia) since 1999 till 2009. Percutaneus vertebroplasty was performed in 167 lesions, radiotherapy was applied in 119 aggressive hemangiomas. Vertebroplasty is more effective for treatment of aggressive hemangiomas in comparison with radiotherapy. Signs of hemangiomas aggression, indications for surgery, and tactics of management were determined. Use of percutaneous vertebroplasty for treatment of aggressive hemangiomas resulted in fast recovery of the patients. This procedure is minimally invasive, it reduces hospital stay and duration of recovery.
Assuntos
Hemangioma/diagnóstico por imagem , Hemangioma/terapia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos RetrospectivosRESUMO
Modern angiographic complexes allow performing emulation of computed tomography (CT). Comparison of the resolving power of XperCT and CT indicated sufficient sensitivity of the new technology in detection of focal lesions of the brain, the possibility of its application in interventional neuroradiology. The application of XperGuide allows control the position of the instrument during operation directly without using additional equipment of moving the patient. The application of XperGuide decreases the risk of intra- and early postoperative complications.
Assuntos
Hemorragia Intracraniana Hipertensiva/diagnóstico , Hemorragia Intracraniana Hipertensiva/cirurgia , Procedimentos Neurocirúrgicos/métodos , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/normas , Encéfalo/patologia , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/normas , Feminino , Humanos , Hemorragia Intracraniana Hipertensiva/fisiopatologia , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neurorradiografia/normas , Procedimentos Neurocirúrgicos/normas , Interpretação de Imagem Radiográfica Assistida por Computador , Fraturas da Coluna Vertebral/fisiopatologia , Avaliação da Tecnologia Biomédica , Tomografia Computadorizada Espiral , Resultado do TratamentoRESUMO
Results of clinical examination and surgical treatment of 1022 patients with tumors of the hypophysis were analyzed. All the patients were operated upon by transsphenoidal endoscopic approach during the recent 10 years. Complications were observed in 76 (7.4%) patients. Most serious of them were: intraoperative mechanical injury of the right internal carotid artery and contact rupture of a large aneurysm of the internal carotid artery falsely diagnosed as craniopharyngioma. In both cases urgent intravascular interventions were necessary which resulted in relief of symptoms and recovery of the patients.
Assuntos
Lesões das Artérias Carótidas/terapia , Artéria Carótida Interna , Artérias Cerebrais/lesões , Embolização Terapêutica/métodos , Endoscopia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/cirurgia , Adulto , Lesões das Artérias Carótidas/diagnóstico , Lesões das Artérias Carótidas/etiologia , Feminino , Seguimentos , Humanos , Doença Iatrogênica , Imageamento por Ressonância Magnética , Procedimentos Neurocirúrgicos/métodos , Nariz , Tomografia Computadorizada EspiralAssuntos
Aneurisma Intracraniano/cirurgia , Hemorragias Intracranianas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares , Adulto JovemRESUMO
The author presents an analysis of using neuronavigation and intraoperative ultrasound in 317 patients after surgical treatment of intracranial tumors. High efficacy of the intraoperative ultrasound visualization has been shown in the detection of remaining parts of the intracranial tumor, improved radical surgery and less lesion to the brain. The strategy of using neuronavigation and intraoperative ultrasound visualization with the tumor size (volume) taken into consideration has been developed.
Assuntos
Neoplasias Encefálicas/diagnóstico , Monitorização Intraoperatória/métodos , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Ultrassonografia Doppler Transcraniana/métodos , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
The paper summarizes the results of examination of 30 individuals aged 27 to 66 years who had extracranial carotid lesions by using computed tomographic angiography (CTA), computed tomography, Doppler ultrasonography, power Doppler imaging, digital subtraction angiography. A procedure for CTA and analysis of data and for determination of the degree of stenosis has been developed. The potentialities of CTA in visualization of extracranial carotid diseases are shown.